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Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, HETA 2009-0074-3114 and HETA 2009-0193-3114, 2010 Sep; :1-45

In January 2009, NIOSH received an HHE request from the American Federation of Government Employees, Local 2718. The request concerned the potential for transmission of TB at the U.S. ICE BSSA facility in Broadview, Illinois. While no known cases of active TB had occurred among employees, the incidence of latent TB infection among employees was unknown. NIOSH investigators made an initial site visit to BSSA on April 8-9, 2009. We walked through the facility and observed work processes, practices, and conditions. We spoke with employees about health and workplace concerns about TB and collected environmental and ventilation measurements. We also held confidential interviews with all 29 employees present at the facility. Most employees reported having daily direct contact with detainees, and none of the employees reported receiving general TB training, respirator fit testing, or respirator training during their employment at BSSA. Many employees were unaware of the ICE recommendation that they undergo periodic TB screening. We also learned that the return air from the detainee areas, including the isolation room, was recirculated throughout BSSA. In addition, all of the detainee areas, including the isolation room, were positively pressurized relative to the adjacent hallway and employee areas. Both situations result in air that was shared between employees and detainees, which could lead to an increased risk of exposure if airborne infectious agents (including Mycobacterium tuberculosis) are present. On July 10, 2009, NIOSH received a second HHE request from the American Federation of Government Employees, Local 2718 concerning the potential for transmission of TB at the ICE CDO in Chicago, Illinois. We made a second site visit to BSSA and an initial site visit to the CDO on August 10-12, 2009. During that visit, we walked through both facilities and observed work processes, practices, and conditions. We spoke with employees about TB-related health and workplace concerns and collected environmental and ventilation measurements. We also screened employees at both facilities for TB with both the TST skin test and QFT GIT blood test methods. At the CDO, the HVAC system in the detainee area is a constant air volume system that exhausts air directly out of the building without recirculation, which is an optimal design. However, the calculated ACH in the holding cells, processing area, and courtrooms were below those recommended by CDC. We also noted that the air flow movement between many of the holding cells and the processing area and between Courtroom B and a secure hallway was bidirectional. These deficiencies can increase the risk of exposure if airborne infectious agents (including Mycobacterium tuberculosis) are present. Most ICE employees participate in job activities that place them at risk of acquiring TB infection, including transporting and interviewing detainees and supervising court visits. Despite this, few participants reported having annual TB screening. Even when we offered TB screening on-site, the number of employees who returned for the TST reading and second step placement was low. All employees who underwent blood collection for the QFT-GIT completed screening. Our evaluation demonstrates the feasibility and practicality of the QFT-GIT as the preferred TB screening method among ICE employees who often have unpredictable schedules. We recommend that the Field Office Director and other local ICE supervisors familiarize themselves with ICE's existing tuberculosis exposure control plan and then develop plans specific for both BSSA and the CDO. A separate constant air volume HVAC system should be designed for BSSA to provide single-pass exhaust ventilation in the detainee holding cells, isolation room, and processing area. Negative pressure should be maintained in these areas relative to all adjacent administrative areas at BSSA. The HVAC system in the detainee areas at the CDO should be rebalanced to provide the appropriate ACH and air flow patterns to minimize the potential for transmission of TB. General training on TB should be provided annually to all employees. All employees should be made aware that annual TB screening is recommended and that it is offered at no cost through FOH. FOH should consider conducting on-site TB screening on predetermined dates and hours at BSSA and CDO and using IGRA testing instead of TST testing to improve participation rates. A respiratory protection program should be implemented for all employees to minimize the potential for transmission of TB. All employees should receive training and medical clearance, and undergo fit testing as defined in the OSHA Respiratory Protection Standard (29 CFR 1910.134).